Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed; each additional vessel treated (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $615.83 | $4,704.00 | $8,728.00 | |
Kaiser Permanente
| Professional | $443.99 | $622.88 | $709.07 | |
Moda Health
| Facility | $270.12 | $542.13 | $815.09 | |
Pacific Source
| Facility | $353.76 | $540.87 | $581.55 | |
Providence
| Facility | $270.12 | $591.22 | $815.09 | |
United
| Facility | $2,364.00 | $7,664.00 | $36,803.00 |